If you're undergoing osteoporosis treatment, you're taking a step in the right direction for your bone health. But perhaps you have questions about your therapy.

Is the medication you're taking the best one for you? How long will you have to take it? Why does your doctor recommend a weekly pill when your friend takes a pill only once a month?

Kurt A. Kennel, M.D., a specialist in endocrinology at Mayo Clinic in Rochester, Minnesota, answers common questions about osteoporosis treatment and describes how osteoporosis medications work.

Which medications are commonly used for osteoporosis treatment?

Bisphosphonates are the most common medications prescribed for osteoporosis treatment. These include:

Alendronate (Fosamax)

Risedronate (Actonel)

Ibandronate (Boniva)

Zoledronic acid (Reclast)

Hormones, such as estrogen, and some hormone-like medications approved for preventing and treating osteoporosis, such as raloxifene (Evista), also play a role in osteoporosis treatment. However, fewer women use estrogen replacement therapy now because it may increase the risk of heart attacks and some types of cancer.

Still, women who have reasons — such as menopausal symptoms — to consider using hormones or who are considering using Evista for breast cancer prevention, can weigh the benefit of improved bone health into their decision.

Denosumab (Prolia) is a newer medication shown to reduce the risk of osteoporotic fracture in women and men. Unrelated to bisphosphonates, denosumab might be used in people who can't take a bisphosphonate, such as some people with reduced kidney function.

Teriparatide (Forteo) is typically reserved for men and postmenopausal women who have very low bone density, who have had fractures or whose osteoporosis is caused by steroid medication. Teriparatide is the only osteoporosis medication that has the potential to rebuild bone and actually reverse osteoporosis, at least somewhat.

How do most osteoporosis medications work?

With the exception of teriparatide, osteoporosis medications slow bone breakdown. Healthy bones continuously break down and rebuild. As you age and, for women, especially after menopause, bones break down faster. Because bone rebuilding cannot keep pace, bones deteriorate and become weaker.

Osteoporosis medications basically put a brake on the process. These drugs effectively maintain bone density and decrease the risk of breaking a bone as a result of osteoporosis.

How do you know if you're taking the right bisphosphonate?

Drugs in the bisphosphonate class are more alike than they are different. Some studies show differences in potency or effectiveness at maintaining bone density, but they're all effective drugs. All bisphosphonates have been shown to reduce the chance of a fracture.

The decision to take one drug over another often is based on:

Preference

Convenience

Adherence to the dosing schedule

Cost

Your doctor might recommend a monthly dose of medication if it's going to be better tolerated or better accepted. But if you're likely to forget to take your medicine on a monthly schedule, you might do better taking one once a week.

When might other osteoporosis medications be used?

Drugs such as denosumab and teriparatide can be used by anyone with osteoporosis, but are more likely to be recommended for people with unique circumstances, including severe osteoporosis with very low bone density, multiple fractures, steroid use and young age. These drugs, which are injected, might also be given to people who can't tolerate an oral bisphosphonate.

What are common side effects of bisphosphonate pills?

The main side effects of bisphosphonate pills are stomach upset and heartburn.

To ease these potential side effects, take the medication with a tall glass of water on an empty stomach. Don't lie down or bend over or eat for 30 to 60 minutes to avoid the medicine washing back up into the esophagus. When the recommended wait time is over, eat to neutralize the remaining medication.

Most people who follow these tips don't have these side effects. But it's possible to take the medicine correctly and still have stomach upset or heartburn.

Osteoporosis: Handout on health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/osteoporosis_hoh.asp#8. Accessed June 13, 2014.

Osteoporosis. American College of Rheumatology. https://www.rheumatology.org/practice/clinical/patients/diseases_and_conditions/osteoporosis.asp. Accessed June 13, 2014.

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